Peyronie’s disease develops when repeated small injuries to the penis trigger an abnormal scarring response in the tough tissue that surrounds the erectile chambers. Most men never notice these micro-injuries when they happen. The problem isn’t the injury itself, which is common and usually heals without issue, but a wound-healing process that goes wrong, producing a fibrous plaque instead of normal tissue. This plaque causes the penis to curve, shorten, or develop indentations during erection.
Estimates of how many men are affected vary widely, from under 1% to over 20% depending on the population studied and how strictly the condition is defined. The peak age for diagnosis falls between 55 and 60, though younger men can develop it too.
The Role of Micro-Injury and Abnormal Healing
The outer shell of the penis, called the tunica albuginea, is a tough, flexible sheath that contains blood during an erection. During sex or other physical activity, this tissue can sustain tiny tears, especially when the erect penis bends or buckles unexpectedly. In most men, these micro-injuries heal normally and go unnoticed.
In men who develop Peyronie’s disease, the healing process overshoots. Genes involved in collagen production, inflammation, and tissue remodeling become overactive in the damaged area, while the genes responsible for breaking down excess collagen and triggering normal cell death become underactive. The result is a buildup of scar-like tissue. Specialized cells called myofibroblasts, which normally contract wounds and then die off, persist and keep producing collagen. Over time, this forms a dense plaque that can harden and even calcify.
The location of the plaque determines the direction and severity of the curve. A plaque on the top of the shaft pulls the penis upward. One on the side causes a lateral bend. Some men develop plaques that create an hourglass-shaped narrowing rather than a curve.
Who Is Most at Risk
Several factors raise the likelihood of developing Peyronie’s disease, and most of them relate to either vascular health or a genetic tendency toward abnormal scarring.
- Age: Risk increases significantly after 50. The average age at diagnosis is 55 to 60.
- Diabetes: Men who have had diabetes for more than 10 years are six times as likely to develop Peyronie’s as men with diabetes of less than five years. Diabetes damages small blood vessels throughout the body, including those in penile tissue, making injury more likely and healing less reliable.
- Smoking: In one study of diabetic men screened for erectile problems, 37% of those with Peyronie’s disease were current smokers, compared to about 19% of those without it. Smoking impairs blood flow and interferes with tissue repair.
- Obesity: Carries a statistically significant association with Peyronie’s, likely through its effects on inflammation and vascular health.
- Connective tissue disorders: About 29% of men with Peyronie’s disease also have Dupuytren’s contracture, a condition where fibrous tissue thickens in the palm of the hand. Both conditions involve the same type of runaway scarring in different parts of the body, suggesting a shared underlying tendency.
- Prostate surgery: Men who undergo radical prostatectomy face a notably higher risk. One study of over 1,000 men found a 15.9% incidence of Peyronie’s disease after the procedure, with an average onset of about 14 months post-surgery. The combination of surgical trauma and prolonged erectile dysfunction likely contributes.
Genetics and Family Tendency
Peyronie’s disease runs in families, and its overlap with Dupuytren’s contracture points to a genetic component in how the body handles scarring. The connection extends to other fibrotic conditions as well. Men with autoimmune disorders, including lupus, Sjögren’s syndrome, and Behçet’s disease, face elevated risk. These conditions involve chronic, misdirected immune activity that can make inflammatory responses harder to shut off, setting the stage for excessive scar formation when tissue is injured.
At the cellular level, research has identified at least 15 genes that are more active in Peyronie’s plaques than in normal penile tissue. These genes govern collagen production, inflammation, and even bone formation (which explains why some plaques calcify). Notably, genes that would normally limit these processes are not correspondingly active, meaning the body’s natural brakes on scarring don’t engage properly.
The Acute Phase: What Happens First
Peyronie’s disease typically progresses through two distinct stages. The first is the acute phase, which generally lasts 6 to 12 months but can stretch to 18 months in some cases. During this window, the plaque is actively forming. Men usually notice pain during erections, and sometimes when the penis is soft. The curve may appear suddenly or develop gradually, becoming more pronounced over weeks or months. Shortening of the penis or new deformities like indentations can also emerge during this time.
This is the period when the disease is changing, which makes it both the most distressing phase and the window where certain treatments aim to intervene before the plaque hardens.
The Chronic Phase: Stabilization
Once the curve, length, and shape of the penis have remained unchanged for three to six months, the disease has entered its chronic phase. Pain typically fades or disappears entirely. The plaque itself becomes more stable and may calcify. The curvature and any deformities remain, but they no longer worsen.
Erectile dysfunction is common in both phases, caused by a combination of the plaque physically restricting blood flow, vascular damage from the same risk factors that contributed to the disease, and the psychological impact of the condition. Not every man with Peyronie’s develops erectile problems, but the overlap is significant enough that it’s considered a hallmark of the disease.
Can You Prevent It?
Because the triggering injuries are usually invisible and unavoidable during normal sexual activity, there’s no reliable way to prevent Peyronie’s disease entirely. What you can control are the modifiable risk factors that make abnormal healing more likely. Quitting smoking, managing blood sugar if you have diabetes, maintaining a healthy weight, and addressing cardiovascular risk factors all reduce the conditions that make penile tissue more vulnerable to scarring.
If you notice a new curve, pain during erections, or a palpable hard spot in the shaft, early evaluation gives you the widest range of options. The condition is easier to address during the acute phase, before the plaque has fully hardened and stabilized.